Some people, however, will not have the benefit of this knowledge before their type-2 diabetes advances to a more dangerous stage. In severe hyperglycemia, the pancreas becomes burned out after producing high levels of insulin for a long time. Insulin levels drop as a result of decreased production, and blood glucose levels are allowed to rise to very high, toxic levels. Although diet and exercise, along with supplementation, are still strongly recommended, a number of prescription drugs might also be necessary.
Sulfonylurea drugs stimulate pancreatic secretion of insulin. Unfortunately, they are often prescribed as first-line treatment for mild to moderate type-2 diabetics, even when their use is inappropriate. By increasing levels of insulin, which are already raised, sulfonylurea drugs actually hasten the progression of early type-2 diabetes by exhausting insulin receptors faster, which causes the pancreas to burn out more quickly. Sulfonylurea drugs should really be considered a "last resort" for people with severe hyperglycemia.
Insulin replacement therapy is also a last resort for type-2 diabetics. While insulin therapy is universal and essential among type-1 diabetics, it is reserved for only severe, refractory (non-responsive to treatment) type-2 diabetics. Proper dosing and monitoring of blood glucose are essential as too much insulin causes low blood sugar and coma, and too little insulin creates hyperglycemia. A new delivery system for insulin was recently approved by the US Food and Drug Administration. This new system allows for inhaled insulin. But the early promise of this therapy has waned as the delivery system had proved unreliable for maintaining a proper dose rate.
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